<%@ page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ taglib prefix="c" uri="http://java.sun.com/jsp/jstl/core"%>
<%@ taglib prefix="fmt" uri="http://java.sun.com/jsp/jstl/fmt"%>
<!DOCTYPE html>
<html lang="zh-CN">
  
  <head>
    
    <%@ include file="/WEB-INF/include/meta.jsp"%>
    <%@ include file="/WEB-INF/include/css.jsp"%>
    
  </head>
  <!-- end header -->
  <body>
    <div class="page-group">
      <div class="page page-current">
        
        <header class="bar bar-nav">
          <h1 class="title pull-left" style="width: 45%; font-size: 1.2rem; color: #F36767;">支付成功!</h1>
          <p class="pull-right" style="width: 55%; font-size: .6rem; line-height: .8rem; margin: .3rem 0;">客服会在1个工作日内联系您！稍安勿躁~</p>
        </header>
        
        <div class="content student-investigation" style="top: 3rem;">
          <h3 class="text-center" style="background-color: #FFFAE1; margin: 0px; line-height: 2rem;">注意</h3>
          <p class="text-center" style="font-size: .7rem; font-weight: bold; padding: 0 2rem;">为了有助于教练了解您个人信息，请您花费1分钟填写以下信息：</p>
          
          <form action="${ctx.host}/shop/investigation" method="POST">
            
            <input type="hidden" name="orderId" value="${order.id}">
            
            <div class="list-block" style="padding: 0 0.75rem;">
              
              <p>请提供您的微信二维码图片*<br><small>方便教练扫码添加学员</small></p>

              <a href="javascript:void(0);" class="upload-image">上传微信二维码(小于2MB)</a>
              
              <input type="hidden" name="mediaId">
              <div class="img-area hide"></div>
            </div>
            
            <div class="list-block">
              <ul>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">身高(cm)：</div>
                    <div class="item-input">
                      <input type="number" name="height" placeholder="请输入身高(cm)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">体重(kg)：</div>
                    <div class="item-input">
                      <input type="number" name="weight" placeholder="请输入体重(kg)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">年龄(岁)：</div>
                    <div class="item-input">
                      <input type="number" name="age" placeholder="请输入年龄(岁)">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">手机号：</div>
                    <div class="item-input">
                      <input type="text" name="wechatNumber" placeholder="请输入手机号">
                    </div>
                  </div>
                </li>
                <li class="item-content">
                  <div class="item-inner">
                    <div class="item-title">邮箱：</div>
                    <div class="item-input">
                      <input type="text" name="email" placeholder="请输入邮箱">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link">
                  <div class="item-inner">
                    <div class="item-title">性别：</div>
                    <div class="item-input">
                      <input type="text" name="sexSelector" placeholder="请选择性别">
                      <input type="hidden" name="sex">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link">
                  <div class="item-inner">
                    <div class="item-title">是否已婚：</div>
                    <div class="item-input">
                      <input type="text" name="marriageSelector" placeholder="请选择">
                      <input type="hidden" name="marriage">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link">
                  <div class="item-inner">
                    <div class="item-title">国家：</div>
                    <div class="item-input">
                      <input type="text" name="countrySelector" placeholder="请选择">
                      <input type="hidden" name="country">
                    </div>
                  </div>
                </li>
                <li class="item-content item-link pcd-select">
                  <div class="item-inner">
                    <div class="item-title">省市区：</div>
                    <div class="item-input">
                      <input type="text" name="pcdSelector" placeholder="请选择">
                      <input type="hidden" name="pcd">
                    </div>
                  </div>
                </li>
              </ul>
            </div>
            
            <div class="list-block has-border" style="margin: 0px;">
              <p style="margin-top: 0px;">邮寄地址</p>
              <div class="input-group">
                <textarea rows="3" name="location"></textarea>
              </div>
            </div>
            
            <div class="list-block has-border">
              
              <p>个人疾病史(如有以下疾病运动损伤史或其他，请一定备注说明）</p>
              
              <div class="input-group" style="margin-left: -.75rem;">
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="患有心脏病">
                  是否患有心脏病
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="患有骨质疏松症">
                  是否患有骨质疏松症
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="有血糖及血压疾病">
                  是否有血糖及血压疾病。
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="有严重的慢性并发症，如心脏，肾，视网膜病变，严重下肢血管病变，植物神经功能障碍等">
                  是否有严重的慢性并发症，如心脏，肾，视网膜病变，严重下肢血管病变，植物神经功能障碍等。
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="手术完仍处于康复期的患者，比如韧带撕裂康复、骨折康复、半月板损伤康复等">
                  是否手术完仍处于康复期的患者，比如韧带撕裂康复、骨折康复、半月板损伤康复等
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="有脊椎及关节变形或损伤、肢体重要骨骼有过骨折史">
                  是否有脊椎及关节变形或损伤、肢体重要骨骼有过骨折史。
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="怀孕或者还处在哺乳期">
                  是否有怀孕或者还处在哺乳期。
                </div>
                <div class="checkbox">
                  <input type="checkbox" name="diseaseDescriptionCheckbox" value="存在其他已知或未知的不适应大强度运动的疾病">
                  是否存在其他已知或未知的不适应大强度运动的疾病
                </div>
                <div>
                  <input type="text" name="diseaseDescriptionInput" placeholder="其他疾病" style="margin: .4rem 0; font-size: 14px; border: 1px solid #ccc;">
                </div>
              </div>
              
            </div>
            
            <div class="list-block has-border">
              
              <p>您是通过哪个渠道得知人马君线上减脂营的？</p>
              
              <div class="input-group" style="margin-left: -.75rem;">
                <div class="radio">
                  <input type="radio" name="source" value="人马君微博">
                  人鱼线VS马甲线（http://weibo.com/ryxmjx）
                </div>
                <div class="radio">
                  <input type="radio" name="source" value="微信订阅号">
                  微信订阅号：人鱼线VS马甲线(ID:ryx_mjx)
                </div>
                <div class="radio">
                  <input type="radio" name="source" value="微信服务号">
                  微信服务号：人马君(ID:fitstart)
                </div>
                <div class="radio">
                  <input type="radio" name="source" value="微信朋友圈">
                  微信朋友圈
                </div>
                <div class="radio">
                  <input type="radio" name="source" value="朋友推荐">
                  朋友推荐
                </div>
                <div class="radio">
                  <input type="radio" name="source" value="其他">
                  其他
                </div>
              </div>
              
            </div>
            
            <div class="list-block has-border" style="margin: 0px;">
              <p>您希望参加人马君后达到怎么样的效果？</p>
              <div class="input-group">
                <textarea rows="3" name="expectations"></textarea>
              </div>
            </div>
            
            
            <div class="content-block" style="margin: 0; padding: 1.75rem .75rem; background-color: #F4F4F4;">
              <a href="javascript:void(0);" style="width: 100%; background-color: #FDDD32; color: #000;" class="button button-big button-success button-fill button-submit">确认提交</a>
            </div>
            
          </form>
          
          <div style="text-align: center; margin-bottom: 20px;">
            <p style="color: #999;"><small>请长按以下客服二维码，获取更多资讯！</small></p>
            <img src="${cloud.prod}/${persist.serviceQrcodes['online-1'].value}-qrcode">
          </div>
          
        </div>
        
      </div>
    </div>
    
    <%@ include file="/WEB-INF/include/script.jsp"%>
    
    <script type="text/javascript">
      var jsConfig = JSON.parse('${wechatJsConfig}')
      require(['page/trading/investigation-create'], function(page) {
        page.init({
          jsConfig: jsConfig,
          orderId: '${order.id}'
        })
      })
    </script>
  </body>
</html>